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The purpose of this study was to estimate associations between cumulative exposure to adverse childhood experiences (ACEs), protective factors, and co-occurrence among male and female juvenile offenders. Cross-sectional study. Validated measures of ACEs, internal resilience, external youth assets, psychological distress, and substance abuse were collected from 429 youths involved in the juvenile justice system in Nevada. A three-level outcome variable was created using the psychological distress and substance use measures: no problems, one problem, or co-occurring problems. Hierarchical multinomial logistic regression models were used to determine the independent, direct, and moderating impact of the protective factors on ACEs and the outcome. Internal resilience, family communication, school connectedness, peer role models, and non-parental adult role models were associated with lower odds of co-occurrence compared to having no problems (adjusted odds ratios [AORs] ranged from 0.11 to 0.33). When ACEs were added to the model, internal resilience and all assets except for one (non-parental adult role models) continued to offer protection against co-occurrence. Internal resilience was the only protective factor that significantly moderated the association between ACEs and co-occurrence (AOR, 0.24; 95% CI, 0.06, 0.99). Most protective factors decreased co-occurring mental health and substance abuse problems in the presence of ACE exposure and internal resilience moderated the relationship between ACEs and co-occurrence. Juvenile justice systems should use positive youth development approaches to help prevent co-occurrence among youths. [ABSTRACT FROM AUTHOR]

Objectives: Adverse childhood experiences (ACEs) are associated with lasting health and behavioral effects. In this study, we assess the relationship between ACEs and gambling in the state of Nevada. Methods: Using 2018 Nevada Behavioral Risk Factor Surveillance System (BRFSS) data, we assessed the relationship between ACEs and gambling behavior among 2768 participants. A composite score was used to assess 10 commonly researched ACEs; this continuous score was additionally categorized into 0 ACEs, 1-2 ACEs, 3 or more ACEs. We used weighted logistic regression to assess the relationship between ACEs scores and frequency of gambling. Results: Approximately 9% of study participants reported frequently gambling (one or more times a month). There was a positive association between the continuous ACEs score and frequently gambling in the fully adjusted model (p = .026). The odds of frequently gambling was 69% higher among those exposed to ≥ 3 ACEs compared to those who had no ACEs exposure (adjusted OR = 1.69; 95% CI 1.00-2.84; p = .048). Conclusions: The results show a relationship between ACEs and gambling in Nevada. This research contributes to the existing understanding of ACEs and their impact.

Objectives: Population-based research on the relationship between concussions and self-harm, depression, and suicidal behaviors among adolescents is limited. Methods: A statewide Youth Risk Behavior Surveillance Survey (YRBSS) was conducted among students from 98 high schools in Nevada in 2017. Students were asked if they had a concussion from playing a sport as well as their mental health outcomes 12 months before the survey. Weighted multiple logistic regression was used to assess the relationship between experiencing a concussion and adverse mental health outcomes. Results: Among 3427 students who were physically active at least 60 minutes per day on 5 or more days per week, or played on at least one sport team, 19.5% (95% CI: 17.31%-21.60%) reported they had a concussion during the past 12 months. After controlling for sex, age, race/ethnicity, and academic performance, students who had a concussion had higher odds of: self-harm [aOR = 1.59 (1.16-2.17), p = .003], depressive symptoms [aOR = 1.48 (1.12-1.94), p = .006], attempted suicide [aOR = 3.10 (2.12-4.53), p < .001] and injury from attempted suicide [aOR = 2.61 (1.31-5.20, p = .006]. Conclusions: Students who experience a concussion may be at increased risk for poor mental health outcomes, including suicide attempts. Psychological evaluation following a concussion should complement medical evaluation and treatment..

Background: Despite today's heightened concern over opioid overdose, the lack of population-based data examining clinical and contextual factors associated with opioid use represents a knowledge gap with relevance to prevention and treatment interventions. We sought to quantify rates of emergency department (ED) visits and inpatient hospitalizations for harmful opioid effects and their sociodemographic differentials as well as clinical correlates in Southern Nevada, using ED visit and hospital inpatient discharge records from 2011 to 2013., Methods: Cases were identified by ICD-9-CM diagnosis codes for opioid poisoning and opioid-type drug dependence and abuse as well as poisoning and adverse effect E-codes. Comorbid conditions, including pain-related diagnoses, major chronic diseases, affective disorders, sleep disorders, sexually transmitted infections and viral hepatitis were assessed from all available diagnosis fields. Counts by age-race per zip code were modeled by negative binomial regression. Opioid injuries were further examined as a function both of neighborhood income and individual characteristics, with mixed-effects logistic regression to estimate the likelihood for an adverse outcome., Results: Opioid intoxications and comorbidities were more common in low-income communities. The multivariable-adjusted rate for opioid-related healthcare utilization was 42 % higher in the poorest vs. richest quartile during the study period. The inter-quartile (quartile 1 vs. 4) rate increases for chronic bodily pains (44 %), hypertension (89 %), renal failure/diabetes (2.6 times), chronic lower respiratory disease (2.2 times), and affective disorders (57 %) were statistically significant. Chronic disease comorbidity was greater among non-Hispanic blacks, whereas abuse/dependence related disorders, alcohol or benzodiazepine co-use, chronic bodily pains, and affective disorders were more prevalent among non-Hispanic whites than nonwhites., Conclusions: There were consistent patterns of disparities in healthcare utilization across sociodemographic groups for opioid-associated disorders. Further initiatives to evaluate the determinants of overdose and abuse and to implement targeted response efforts are needed.

Background: The impact of adverse childhood experiences (ACEs) on adult alcohol consumption is well-established, but little is known about the association with alcohol use during pregnancy., Methods: Using data from the 2010 Nevada Behavioral Risk Factor Surveillance System, we assessed the relationship between ACEs and alcohol use during pregnancy in a representative sample of 1,987 adult women. An established ACEs scale was used to assess a range of childhood physical, emotional, and sexual abuse and household dysfunction (range, 0-8). Weighted logistic regression was used to assess the relationship between ACE scores and alcohol use during pregnancy after controlling for drinking before pregnancy and other covariates., Results: Six percent of participants reported drinking alcohol during pregnancy. After controlling for race/ethnicity, age, employment status, smoking status, and prepregnancy alcohol use, increasing ACEs were positively associated with higher odds of alcohol use during pregnancy (1 ACE: adjusted odds ratio [AOR], 2.92; 95% CI, 1.08-7.87), (2-3 ACEs: AOR, 3.52; 95% CI, 1.46-8.48), and (≥4 ACEs: AOR, 4.79; 95% CI, 2.14-10.72). Prepregnancy drinking was also strongly associated with alcohol use during pregnancy (AOR, 11.95; 95% CI, 5.02-28.43)., Conclusions: We found evidence of a dose-response relationship between ACEs and alcohol use during pregnancy that remained even after controlling for prepregnancy drinking and other covariates. Screening women of childbearing age as well as pregnant women for ACEs may be an effective way to identify and address many of the emotional, behavioral, and physical sequelae of childhood adversity., (Copyright © 2015 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.)

Background: Interpregnancy interval is a risk factor for various adverse birth outcomes including birth defects. We investigated the relationship between interpregnancy interval and birth defects., Methods: We conducted a retrospective cohort study using linked data from Nevada Birth Outcomes Monitoring System and birth certificate data for 124,341 singleton live births, of which 4641 infants had 7192 birth defects, among Nevada resident women between 2006 and 2011. We used logistic regression to assess factors independently associated with birth defects., Results: Women who had an interpregnancy interval of 36 months or more, adjusted odds ratio (AOR) = 1.16, 95% confidence interval [CI], 1.01-1.33, were more likely to have an infant with a birth defect compared with women with an interpregnancy interval of 18 to 23 months. Other independent risk factors for birth defects included male infants, AOR = 1.34, 95% CI, 1.26-1.42; maternal age (30-34 years) and advanced maternal age (35 years and older), AOR = 1.10, 95% CI, 1.01-1.19 and AOR = 1.29, 95% CI, 1.18-1.42, respectively; being a Black woman, AOR = 1.46, 95% CI, 1.32-1.61; three and four or more previous births, AOR = 1.12, 95% CI, 1.02-1.23 and AOR = 1.24, 95% CI, 1.11-1.38, respectively; smoking, AOR = 1.23, 95% CI, 1.10-1.38; and prescription drug use, AOR = 1.14, 95% CI, 1.07-1.21., Conclusion: A long interpregnancy interval is an independent risk factor for birth defects. It may be helpful for maternal and child health programs and health care providers to highlight the deleterious effects of a long interpregnancy interval., (© 2015 Wiley Periodicals, Inc.)

Background: Medication therapy management (MTM) services provide essential reviews of drug regimens and are increasingly recognized as beneficial to patient safety, improved health outcomes, and cost savings., Objective: To assess patient behavioral outcomes from an MTM service, including actions following receipt of a pharmacist report., Methods: A retrospective analysis of an MTM program at the Sanford Center for Aging (NV, USA) was conducted. Outcome measures included whether the patient discussed the review with the physician, whether any changes in the client's drug regimen occurred, and whether the client feels more knowledgeable about his or her medications. Predictor variables included basic demographics, prescription insurance status, number of prescriptions taken, self-reported health status, and use of medications considered to be high risk. The analysis plan involved the use of multivariate logistic regression models., Results: The odds of discussing the medication review with physicians, making changes recommended in the report, and both discussing and making a change were 65%, 60%, and 67%, respectively, lower among those below poverty level than among those above poverty level; 95% confidence intervals (CIs): 0.15, 0.80; 0.18, 0.85; and 0.15, 0.73, respectively. The odds of those using high-risk drugs of making changes in drug regimens, and of discussing with physicians and making changes together, were 2 times higher than the odds of those not using these drugs, 95% CIs: 1.02, 4.31 and 1.20, 4.87, respectively. The likelihood of those reporting good or excellent health of doing the combination of discussing the MTM report with physicians and to make a drug regimen change was 2 times greater than for those reporting poor to fair health, 95% CI: 1.08, 3.65. Gender, ethnicity, age group, rural status, prescription drug insurance, and high polypharmacy were not significant factors for acting on the medication review in the adjusted model., Conclusion: MTM services are associated with enhanced patient self-advocacy, but like other interventions, they are constrained by social disparities. Greater attention to the resources of target populations to respond to pharmacy services is merited., (Copyright © 2012 Elsevier Inc. All rights reserved.)

The town of Fallon within Churchill County, Nevada exhibited an unusually high incidence of childhood leukemia during the years 1997-2003. We examined the temporal and spatial patterning of the leukemia case homes in comparison to the distribution of the general population at risk, other cancer incidence, and features of land use. Leukemia cases were predominantly diagnosed during the early to mid summer, exhibiting a seasonal bias. Leukemia cases lived outside of the "developed/urban" area of Fallon, predominantly in the "agriculture/pasture" region of Churchill County, circumscribing downtown Fallon. This pattern was different from the distribution of the underlying population (p-value<0.01) and different from the distribution of other cancers, which were evenly distributed when compared to the population (p-value=0.74). The unusual space-time patterning of childhood leukemia is consistent with the involvement of an infectious disease. A possible mode of transmission for such an infectious disease is by means of a vector, and mosquitoes are abundant in Churchill County outside of the urban area of Fallon. This region harbors a US Navy base, and a temporally concordant increase in military wide childhood leukemia rates suggests the base a possible source of the virus. Taken together, our current understanding of the etiology of childhood leukemia, the rural structure combined with temporal and geospatial patterning of these leukemia cases, and the high degree of population mixing in Fallon, suggest a possible infectious cause., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Background: An increasing USA population, especially as a result of foreign immigration, has been the recent focus of healthcare research and policy debate. However, little is known about domestic immigration and its impact on the measures of health conditions and behaviours used to develop and evaluate public health policies and programmes. The objective of this research is to compare health conditions and behaviours between domestic immigrants and established residents in Nevada, the fastest-growing state in the USA., Methods: The Nevada 2004-2006 Behavioural Risk Factor Surveillance Survey and added state residency questions were used to examine the associations between length of residence and 24 explanatory variables on health behaviours and conditions. Weighted multiple logistic regressions were used for data analyses., Results: Among the 8663 respondents weighted to the total Nevada population, long-term residents (5 to <10 years), compared with newcomers or short-term residents, were more likely to report fair or poor health (OR=1.98, 95% CI 1.15 to 3.40) and obesity (OR=2.18, 95% CI 1.10 to 4.32), and to live with firearms in the home (OR=6.34, 95% CI 1.75 to 22.9). They were less likely to report having diabetes (OR=0.49, 95% CI 0.25 to 0.96), having had an HIV test (OR=0.60 95% CI 0.41 to 0.89), having prostate cancer (OR=0.20 95% CI 0.04 to 0.93) or having had a mammogram (OR=0.41, 95% CI 0.25 to 0.70)., Conclusions: Long-term residents, compared with newcomers, provide a unique comparison group that share the same physical and policy environment but in different time periods. Knowledge of differences such as these can improve the specificity in identifying target groups for particular interventions.

This study examined the association between particulate matter < or =10 microm in aerodynamic size (PM(10)), carbon monoxide (CO), and ozone (O(3)), and birth weight in Washoe County, NV, from 1991 through 1999. In total, 39,338 single births were included in this study. The mean birth weight was 3383 +/- 460 g and prevalence of low birth weight (LBW) was 2.46% for single births with a gestational age of 37-44 wk. After controlling for cofactors including infant sex, maternal residential city, education, medical risk factors, active tobacco use, drug use, alcohol use, prenatal care, mother's age, race and ethnicity of mothers, and weight gain of mothers, we found PM(10) exposure in the third trimester of pregnancy to be a significant predictor of birth weight of newborns. A 10-microg/m(3) increase in the 24-h PM(10) level in the third trimester of pregnancy can be associated with a birth-weight reduction of 11 g (95% CI: 2.3-19.8 g) using multiple linear regression; however, PM(10) was not found to be related with the risk of LBW from logistic regression. CO and O(3) were not found to be associated with birth weight or risk of LBW of newborns by the same modeling procedure. The results suggest PM(10) could be a risk factor associated with birth-weight reduction of newborns in urban northern Nevada; however, the current level of PM(10) is not a risk factor to increase the chance of LBW newborns.

This study assessed the association between ambient PM(10) pollution and daily hospital admissions for chronic obstructive pulmonary disease (COPD) in Reno-Sparks, Nevada, for the period 1990-1994. All three hospitals in the region were included. There was a total of 3115 admissions for COPD during this period. Daily ambient PM(10) values were available from one of seven air monitoring stations in this region. Weather variables including temperature and wind speed were also collected from this station. The daily average concentration of PM(10) was 36.55 microg/m(3). The generalized additive model (GAM) was used in the whole analysis. After adjusting for the effects of weather variables, day of week, seasons, and time trend, the results show that PM(10) is a statistically significant predictor for daily hospital admissions for COPD. The relative risk (RR) of hospital admissions for COPD for an interquartile increase (26.6 microg/m(3)) of the 24-h average level of PM(10) is 1.049 (95% CI 1.011-1.087).